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Consultant, Ph.d. Jens Lauritsen, - Ortopedic Dept., University Hospital, - Dept. Public Health, Biostatistics Unit. University of Southern Denmark. [email protected] Before using Statistics we must agree on:

• Purpose and datasources • Which classification systems to use • How much of our time to spent on collection of data 2 and to use it • How to balance society vs. individual - ethical considerations. • Who is to pay - the collector or the user

J.Lauritsen Issues in establishing valid registration November 2011 Counting is not a new thing !

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J.Lauritsen Issues in establishing valid registration November 2011 How to prioritise The epidemiological approach

• Do we have a problem - How many ? (incidence and prevalence) • How do we describe the problem ? (record details - how did it happen) 4 • Is there a ”social” gradient ? (Even population distribution - Males females, low-high income, young - old .....) • How do we understand the problem - scope ?

J.Lauritsen Issues in establishing valid registration November 2011 >············ An accident ·······················<

Pre injury contact/injury consequence The person age, gender, short time morbidity fracture wound 5 bruise ... Environment place of residence , furniture, availability of assistance, Long time suitability of home fear function ...

J.Lauritsen Issues in establishing valid registration November 2011 Based on Tuominen and Saari, J.Occup Acc. 1984 An accident -----> preventive strategies

Pre injury Contact/injury Consequence The person short time training, treatment of balance/gait immediate disorders, treatment medication... alarm systems 6 Environment hand rails, carpets, footsteps, sufficient hip padding long term light ... rehabilitation ...... change of residence ... J.Lauritsen Issues in establishing valid registration November 2011 Based on Tuominen and Saari, J.Occup Acc. 1984 AppreciateKommunen tilbyder political decisionKommunen at har thehaft en særlig local uge med level. ForebyggendeE.g. Træning focus on training fokusin municipalities på aktivitet og træning for ældre.

Bogense Otterup

Middelfart 7 Søndersø Kerte- Søndersø Kerte- Nørre Åby minde Nørre Åby minde Næsby Næsby Munkebo Tarup Ejby Skibhus Ejby Skibhus Hunderup Øst Vissenbjerg Langeskov Årup Vest Indre By Indre By Øst Rosen- Årup Vest Rosen- gård gård Ullerslev Hjallese Dyrup Nyborg Tommerup Årslev Årslev Glamsbjerg Ørbæk Ørbæk Assens Broby Assens Ringe Broby Ringe Hårby Ryslinge Hårby Ryslinge Gudme

Fåborg Egebjerg Nord Fåborg Egebjerg Nord Øst Vest Tranekær Øst Vest Tranekær J.Lauritsen Issues in establishing valid registration November 2011 Syd Syd

s23 Rudkøbing Rudkøbing Ærøskøbing Nej Ærøskøbing Marstal Ja s3 Sydlangeland Nej Sydlangeland Ja Organisation and distribution of responsibility - we perceive this :

Region 8 person Municipality (County)

Free of Dependent disease

J.Lauritsen Issues in establishing valid registration November 2011 Organisation and responsibility - but this is reality

County Kommune Amt Family, club 9 person

Municipality

J.Lauritsen Issues in establishing valid registration November 2011 Publish quality indicators

• Completeness of Your registry (for our hospital 40 % go to hospital) • Precision of information. – We know > 90 % the name of the street where traffic injuries occurred 10 – But we lack the precise location for 40 % • Enhance quality with new methods, (but do not spent all resources on fancy equipment) • Appreciate the need for motivation, management devotion and resources for courses and feedback.

J.Lauritsen Issues in establishing valid registration November 2011 Place of Occurence

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J.Lauritsen Issues in establishing valid registration November 2011 Ability of hospitals to record these data ?

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J.Lauritsen Issues in establishing valid registration November 2011 From data to priority – new methods

Grid data counting of outcome and numerator 13

J.Lauritsen Issues in establishing valid registration November 2011 Decision exercise

Person question the munizipality: “It is dangerous here 14 – do something”

Information: Police based injuries: 1 accident Decision ?

J.Lauritsen Issues in establishing valid registration November 2011 In hospital 18 injured persons treated from same period Several in the same spot.

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Decision: What is the answer ?

J.Lauritsen Issues in establishing valid registration November 2011 Prevention can demand a clinical approach - e.g. falls

Visits to a hospital in 18 months- population 10.000 Agegroup stumbled fell from height 16 70-79 302 117 80-89 410 77 90+ 118 14

Think of the personnel need to find out if these need training

J.Lauritsen Issues in establishing valid registration November 2011 Appreciate the possible change in nature of accidents - from technical to “public health”/sociological solutions

• Early: technical solutions might be appropriate. 17 Major part of the room for prevention • Later - complex situation. Behaviour and mode of transportation. - example child, trucks and roundabouts

J.Lauritsen Issues in establishing valid registration November 2011 When acting develop quality assurance measures - e.g.

• Before/after measurements of road crossings • structured assessments of every day situation 18 – what are you eating, how do you handle food preparation, which social habits do you value ... • Standardised functional tests – for individual follow up and for priority setting

J.Lauritsen Issues in establishing valid registration November 2011 In summary: we should align and count

J.Lauritsen Issues in establishing valid registration November 2011 The problem is, that we cannot align !

J.Lauritsen Issues in establishing valid registration November 2011 Conclusion

We thought that counting was enough – In particular if we counted with detailed parameters – Someone else would obviously act !

• BUT: Creation of practical statisics and prevention is much 21 more than collecting data and making tables • resources - who pays • room for local influence • statistical analysis is more than tabulation • room for action • work with targets of interest • agree on goalsetting in a political setting – J.Lauritsen Issues in establishing valid registration November 2011 The outside system is in progress

Web links:

Ouh.dk/uag Www.epidata.dk

J.Lauritsen Issues in establishing valid registration November 2011 Web links

www.epidata.dk www.ouh.dk/uag 23

J.Lauritsen Issues in establishing valid registration November 2011